A healthy diet combined with regular, appropriate exercise and physical activity will improve strength, endurance, flexibility and general health and fitness and can help reduce fatigue and pain.

“Exercise is very important because it builds up and strengthens the muscles that support the joints — and that helps take some of the stress and strain off the arthritic joint,” Dr. Dore says. “Twenty to 30 minutes of some sort of regular, low-impact exercise three to four times a week is very beneficial. Mix up the type of exercises you do so you don’t get bored. And make sure to warm up your muscles by flexing and stretching before you begin. Don’t go a day without some kind of exercise.”

The following are some types of exercise particularly beneficial to folks with arthritis. The American College of c suggests the exercises be done at a rate of moderate exertion. That means the exerciser can speak normally, doesn’t get out of breath or overheated and can carry on the exercise activity at a comfortable pace.

Flexibility and stretching exercises — These should be gentle and low in intensity. They improve range of motion, function and help lower risk for injury.

Muscle conditioning for strength and endurance — More vigorous, these are usually done every other day. They work the muscle — making it bigger, stronger and able to work longer without tiring. Exercises can include lifting free weights, working out on a weight machine and/or resistance training with elastic bands.

Cardiorespiratory and aerobic conditioning — These work the large muscles in rhythmic and repetitive movements. They improve heart, lung and muscle function and can include walking, swimming, aerobic dance, aquatic aerobic, bicycling and working out on a treadmill or rowing machine.

Daily exercise — These include just about anything that gets you up and moving: mowing the lawn, raking leaves, sweeping, playing golf and walking the dog.

Physicians with the Arthritis Foundation recommend you see your physician if you experience pain, stiffness or swelling in or around a joint or difficulty in moving a joint for more than two weeks. Early diagnosis and treatment are key in helping slow or the prevent damage that can happen in the early stages of the disease.

“In the last two years, we’ve narrowed the gap in what we’re doing in the lab and what we’re doing in the clinic,” Dr. Cohen says. “I think we’re going to make some very dramatic findings in the next 10 to 20 years, and I fully expect a cure.”

Initial treatment may be medications — such as ibuprophen, Naprosyn, Vioxx or Celebrex — that relieve pain and reduce inflammation. But as the disease progresses, patients move on to a disease-modifying, anti-rheumatic drug like methotrexate — which can cause tiredness, intestinal problems or thinning hair — or the relatively new Arava — which can take one to three months to kick in — and combination therapies. Surgeons can replace painful arthritic joints with artificial ones.

Lupus
Lupus is a chronic autoimmune disease that causes various parts of the body to become inflamed — skin and joints, but also kidneys, heart and lungs. The body’s immune system turns on itself by making a substance that damages its own tissues. Folks at the Lupus Foundation of America figure between 1.4 and 2 million people have lupus — about 90 percent are women.

Because its symptoms are so varied, lupus can be difficult to diagnose, and the disease is often misdiagnosed as rheumatoid arthritis. “The average patient goes two or three years with lupus before visiting a doctor and getting a diagnosis,” says Dr. Daniel Wallace, clinical professor of medicine at the UCLA School of Medicine, co-chair of the Lupus Foundation of America Inc., and the author of “The Lupus Book” (Oxford University Press, $25, 2000). “Most simply dismiss their symptoms.” Some symptoms can be typically arthritis-like — achy joints, swollen joints and tiredness — but others can include fever, skin rashes, anemia, kidney inflammation, pleurisy (painful deep breathing), sun or light sensitivity, hair loss, Raynaud’s phenomenon (fingers turn white or blue when cold), mouth or nose ulcers, and seizures. Lupus patients can experience periods of remission, where they have few, if any, symptoms.

“There are basically two types of lupus — good lupus and bad lupus,” says Dr. Daniel Wallace. “The good lupus is non-organ-threatening — meaning it hasn’t affected the heart, lungs and other major organs. With this, you can have a good quality of life and normal life expectancy.

But about half of lupus patients have the organ-threatening type, and they will die within the first five years of the disease.” Patients with lupus are prescribed drugs depending on which organ or organs are involved. Initial treatment for lupus can include ibuprophen,

Naprosyn, Vioxx and Celebrex. Antimalarial drugs like chloroquine or hydroxychloriquine may be prescribed to treat skin and joint symptoms for lupus. Side effects are rare but may include diarrhea or rashes. Some antimalarials can affect the eyes, so it’s important to see an ophthalmologist before starting the drug and to make regular visits while taking it.

Steroids — like prednisone — may be prescribed in the beginning for non-organ-threatening lupus and for a while in organ-threatening lupus. They can have side effects like weight gain, a round face, acne, easy bruising, osteoporosis, high blood pressure, onset of diabetes, cataracts, stomach ulcers, and increased risk of infection.

Cytotoxic drugs are usually combined with high doses of steroids. Possible side affects are anemia, low white blood cell count and increased risk of infection. They may also predispose a patient to develop cancer. Currently, several drugs are being studied for use in treating lupus, and physicians are using drugs in combinations to treat individual patients’ needs.

Diet and Exercise

It’s extremely important for folks with arthritis to maintain a healthy weight — excess weight puts a strain on hips, knees, feet and back.

In fact, studies show overweight and older women can significantly lower their risk for osteoarthritis of the knee by losing weight and maintaining a healthy weight.

“While aging and genetics do play a role in the development of osteoarthritis, probably one-quarter to a half of all women can lower their risk factor for the disease by reaching and maintaining a weight that’s 25 or under on the body mass index,” says Dr. Karp.

For now, no one knows why. But we’ve got it in a big way.

“It’s true. I can go an entire day — even two — without seeing a single male arthritis patient,” Dr. Robin Dore, an associate clinical professor at UCLA School of Medicine in private practice.

That’s if we even bother to see a doctor. Too often, we dismiss the warning signs of arthritis as simply twinges of “overdoing it” or the inevitable aches and pains of growing older. In a recent survey by the Centers for Disease Control and Prevention, 40 percent of those surveyed said they had arthritis but hadn’t seen a physician because they figured nothing could be done. Big mistake. While there is no cure for arthritis, there’s real help.

“With rheumatoid arthritis, 50 percent of joint damage occurs within the first two years of the disease,” says Dr. Stanley Cohen, director of the Metroplex Clinical Research Center in Dallas, Texas, and a clinical associate professor of internal medicine at the University of Texas Southwestern Medical Center. “If we see it early on, there’s time for intervention which can help control the disease and prevent further damage.”

Osteoarthritis
Osteoarthritis is one of the most common types of arthritis and the leading cause of disability in the United States. It currently affects 15.3 million women — about 74 percent of all diagnosed cases. Often called the “wear and tear” arthritis, osteoarthritis occurs when the cartilage — which cushions the joints where bones meet — breaks down. The bones rub together causing pain and loss of movement in the affected joint.

Discomfort from osteoarthritis can range from very mild to very severe. The top risk factors for osteoarthritis are previous injuries to the joint, genetics and age. But contrary to popular belief, osteoarthritis is not an inevitable part of aging, Dr. Dore says. In fact, some women don’t experience any symptoms at all.

Typically, women who develop symptoms develop them after menopause — usually around age 55, Dr. Dore says. “Maybe you’ll notice a little joint stiffness after sitting awhile — like at a movie — or when you wake up in the morning,” she says. “It can occur in your hands, knees, feet, hips or back. But osteoarthritis doesn’t usually spread. It can stay localized forever because cartilage deteriorates in different joints at different rates.”

Currently, treatment includes drugs that relieve pain — like acetaminophen — and nonsteroidal anti-inflammatory drugs (NSAIDs) that relieve pain and reduce inflammation — like ibuprophen and naprosyn — which can irritate the stomach. They are available without a prescription.

Relatively new prescription drugs include Vioxx and Celebrex, which are easier on the stomach. In addition, food supplements glucosamine and chondroitin, which have been used by veterinarians on horses and dogs “show promise,” says Dr.

David Karp, an associate professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas. “They suggest a slowing down of cartilage damage and don’t seem to have any side effects. But they should not be used as the first line of treatment.” In very painful cases, surgeons can replace the arthritic joint with an artificial one.

But since artificial joints only last about 20 years, physicians usually try to hold off as long as possible so the replacement doesn’t have to be repeated.

Rheumatoid Arthritis
Rheumatoid arthritis is one of the most serious and disabling types of arthritis. It affects 1.5 million women — or 71 percent of all cases — usually between the ages of 20 and 45. It’s a chronic disease that causes the lining of the joint to become inflamed. The inflamed cells release an enzyme that eats away bone and cartilage, which causes pain, stiffness, swelling, tiredness and loss of movement.

If there ARE memories of your accident of which you’re not aware, can — or should — you retrieve them? One possibility is to consult with a licensed professional experienced in hypnosis. But please keep in mind that research has indicated hypnosis doesn’t necessarily increase the ACCURACY of memory, while it does increase CONFIDENCE in even false or distorted memory.

There’s another option, however, that comes to mind: If it ain’t broke, don’t fix it. You say you’ve gotten closure on your accident and its aftermath and are no longer experiencing post-traumatic symptoms. Why expend more time and energy trying to dredge up memories that may not even exist? You can now give thanks that you’ve survived the accident, recuperated emotionally as well as physically, and completed a book about your experiences. Perhaps now it’s time to shift your focus to the future and let go of any remaining ties to the past.

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Marty

A. Current scientific understanding is that in order to permanently store an experience in memory, it must be encoded and transferred from short-term memory to long-term memory. When someone has had a severe physical trauma — particularly one in which he or she was knocked unconscious — the encoding and storage process may be aborted before the memories of events around the time of the trauma are moved from short-term into long-term memory storage. As a result, there may be no narrative or visual memory of the trauma that can later surface or be retrieved.

However, the body’s nonverbal response to the trauma (complete with adrenalin-driven stress reactions to life-threatening danger) may continue to be triggered and re-enacted in what some refer to as “body memories.” (These reactions can also be thought of as conditioned responses — like Pavlov’s dogs, who were fed after the experimenter rang a bell and soon began to salivate at the sound of the bell, the body of the traumatized individual may automatically respond to stimuli that remind him or her of the trauma.) Body-centered and nonverbal approaches can often help interrupt and resolve these types of traumatic symptoms.

Many mishaps occur at work or home so it is extremely important to become ready and also to protect your children and family. Buy reliable, safe, appropriate first aid kits from a wide assortment of specialize first aid resources.

For the most part, however, patients who are successfully treated for cervical cancer have little, if any, side effects from treatment and live normal lives. The presence of symptoms after treatment may be a sign of the disease’s recurrence and should be investigated by a gynecologic oncologist.

Emotional Effects of Cervical Cancer
Patients treated with radiation almost always lose the benefits of estrogen because the ovaries are extraordinarily sensitive to radiation. These women should be given hormone replacement therapy unless there is some contraindication for this.

Women who have surgical therapy usually can have ovarian function preserved and hormone replacement therapy is not necessary. Without estrogen replacement therapy, the emotional effects of cervical cancer can be compounded by hypoestrogenism and its emotional side effects.

Other emotional effects of having cervical cancer can include a feeling of being “unclean” because of a genital tract disease, although this is more often a cultural issue. Sometimes a woman will have emotional difficulty with her view of her sexuality after a hysterectomy. Also, the emotions that result from no longer being able to have children cannot be underestimated.

Effects of Cervical Cancer on Family and Friends
In the early stages, cervical cancer has few side effects. Hence the effects on family and friends primarily involve the emotional effects of having a loved one diagnosed with cancer.

For patients who undergo radiation therapy, there can be a significant impact on family logistics because radiation therapy requires multiple trips to the hospital.

The addition of chemotherapy to radiation therapy may add to this burden. As many as 25 to 30 trips to the hospital may be necessary to complete a course of radiation therapy and this can have a significant impact on the family. Follow-up visits for patients who are treated with radiation therapy and surgery occur three or four times a year, as long as things are going well.

What Is Your Doctor Concerned About?
The doctor is always concerned about whether the patient is being regularly screened for cervical cancer.

Once patients have been diagnosed with cervical cancer, doctors are most concerned that the mode of treatment fits the appropriate stage of disease and that the patient understands and follows through with recommended treatment.

Finally, doctors are concerned that patients return for follow-up visits and report any unusual symptoms that appear between scheduled appointments. That way, if the cancer recurs, it can be diagnosed promptly and treated, if possible.

As the disease becomes more advanced, growth toward the sidewalls of the pelvis may cause the cancer to partially or completely block the ureters. Complete ureter blockage can lead to death because of uremia (the inability of the body to excrete waste), which causes uremic poisoning. This is relatively rare in developed countries because of widespread healthcare, but is not uncommon in undeveloped countries.

Because the uremic poisoning symptoms, such as nausea, fatigue, sleepiness and eventually coma, are similar to other major illnesses, this condition may be seen as just a sign of old age. Sometimes these patients do not even receive a simple pelvic exam, which could save their lives.

The physical effects of cervical cancer after treatment may be more remarkable. Patients who have a LEEP or conization procedure may experience cramping, bleeding or a watery discharge. After a hysterectomy, the woman may experience pain in her lower abdomen for a few days after the operation. Women may also have difficulty emptying their bladder for a few days and trouble having normal bowel movements. However, normal activities, including sexual intercourse, can usually be resumed in six to eight weeks.

Patients who have radiation therapy, which is usually reserved for more advanced stages, can experience sexual dysfunction, as the vagina may become shorter, more narrow and less flexible. They may also experience difficulty with urination because of the radiation shrinking the bladder and the loss of overall bladder tone. Difficulty with bowel movements may result because radiation can cause the rectum to change size. Some of the more serious radiation side effects may include bleeding from the rectum and bladder, as well as blockage of the intestines and prolonged diarrhea.

Radiation therapy also tends to make patients feel very tired, especially in the latter weeks of treatment. It is common for patients to lose hair — but only in the treated area — and for their skin to become dry, reddish and itchy.

Some patients who are treated with a combination of surgery and radiation can have lower extremity swelling, or edema, which can be disabling, but rarely life-threatening. Also, there may be some changes in sexual function if the cervix is surgically removed or changed due to radiation.

Remember that you have the final say about your treatment. If you are considering medications and your physician recommends PTU, ask about taking methimazole. It is just as effective as PTU, and you can usually take half the number of pills every day.

For example, taking three tablets (10 milligrams each) of methimazole each morning is equivalent to taking two tablets (50 milligrams each) of PTU three times each day. Neither medication is very expensive.

If you are considering surgery, be sure that you are referred to a surgeon who is experienced in performing thyroidectomies and who continues to do them frequently. When you talk to the surgeon, ask whether many of his or her patients have had problems after surgery with hoarseness or low calcium levels. It is also important that the anesthesiologist who puts you to sleep for surgery has had experience working with hyperthyroid patients.

Many primary care physicians do a good job of caring for patients with Graves’ disease. However, if your questions are not being answered to your satisfaction, or if you feel as though you are not making progress with your therapy, then ask for a second opinion from a physician who specializes in treating thyroid problems and other hormonal conditions.

Such specialists are called endocrinologists. Referrals to an endocrinologist and an eye specialist (ophthalmologist) are also important if you have Graves’ eye disease.

If you have severe eye disease that may require surgery, then you will need to see an ophthalmologist who specializes in the treatment of Graves’ eye disease. Most ophthalmologists do not have experience with this type of surgery.

On rare occasions when a patient’s vision is threatened, such a referral needs to be made on an urgent basis.

Space

Space is often the biggest obstacle to starting a children’s fitness program. Ideally, one room should be designated for kids’ fitness. This makes it easier on staff since equipment does not have to be moved, and allows for the area to be decorated with children in mind. It also communicates to your members that kids’ fitness is important. Rooms should be approximately 800 square feet and allow 16 kids to fit comfortably. To get maximum exposure for your program, an unused racquetball court is ideal. Since courts have tall walls, paint fun murals to counteract the “canyon” effect.

If one room cannot be designated solely for children’s fitness, find a space that is safe and enclosed. Children must be contained so instructors can concentrate on teaching them, not corralling them. It is best not to have adult equipment in the room, as children will be tempted to climb on it or try to use it. Make sure you have a closet for storage that includes shelves and hooks.

Lesson plans

Lesson plans help ensure a smooth class and appropriate sequence of learning (see the sample lesson plan). They should be written for every class and changed for each age group. Included should be the class theme, equipment needed and skills to be learned. Posting an overview of each class helps instill confidence in parents that the program is fun and organized, and helps generate interest among other members. It also gives a basis for the parents to ask their children questions about their participation.

Weekly themes

A healthy childhood usually leads to a healthy adulthood, so it is important to teach children at a young age the benefits of exercise and eating right. Incorporating a theme into each class that focuses on one or two aspects of healthful living is a great way to introduce good habits to children. Themes should be written into lesson plans and discussed at the beginning and end of every class. Topics can range from Vitamin C and water, to car safety and smoking. Themes can be reinforced at home by sending notes to parents and letting them know what is being emphasized that week. After all, by creating a kids’ fitness program, you are basically entering into a partnership with parents — a partnership that will likely lead to healthy kids, healthy adults and healthy families.

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Finding expert staff should be one of your top priorities. Hire a program director who is qualified to teach all ages of children and who has the experience to promote and direct your program. The ideal person should be athletic, fun-loving, reliable, energetic and experienced with a background in physical education, early childhood development or a related field. The program director should serve as the lead teacher in your program. By teaching classes, the director will be familiar with the programs and families, and will be more qualified to train new staff. Two to six other staff members can be assistant teachers, with one to run the parent/toddler program. (A parent can be a good choice since he or she will likely be comfortable with children and adults.) Training new staff should include sharing your mission statement, philosophy and objectives.

Safe equipment

Put together an equipment budget and order early since it can sometimes take up to eight weeks for supplies to arrive. Buy safe, colorful, durable and easy-to-store equipment, particularly if your program shares a room with other exercise classes. Children are naturally drawn to objects that evoke a desire to play, such as mats for rolling and jumping, balance beams for walking, hoops to jump into and scarves for dancing. Each child should have his/her own small piece of equipment like a jump rope, hula hoop, bean bags or balls. This takes away from competitiveness among children when working on specific skills and activities.

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